Healthcare Provider Details

I. General information

NPI: 1043530892
Provider Name (Legal Business Name): G.F. ATWELL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LEIGHTON AVE SUITE 401
ANNISTON AL
36207-5700
US

IV. Provider business mailing address

901 LEIGHTON AVE SUITE 401
ANNISTON AL
36207-5700
US

V. Phone/Fax

Practice location:
  • Phone: 256-236-6090
  • Fax: 256-236-0713
Mailing address:
  • Phone: 256-236-6090
  • Fax: 256-236-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3652
License Number StateAL

VIII. Authorized Official

Name: G FRED ATWELL
Title or Position: PRESIDENT
Credential: DDS
Phone: 256-236-6090